2019-11-14T10:38:50-06:00 2018-12-31 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2018-01-01 411801967 SIBLEY MEDICAL CENTER SIBL 5079642271 601 WEST CHANDLER STREET ARLINGTON MN 55307 GORDON GABLENZ CFO & CIO 5079642271 2019-11-08 1 DARRYN MCGARVEY P00958683 6123764500 67.137.57.251 2019-11-08 07:23:20 CS P 3504379F24C0DE3CDF94D2B924EA8FE5CB423EB9 F40EF91B43A03FD1C882785D0956003FD1A535BB 2018 2020-04-17 16:48:07Z RIDGEVIEW SIBLEY MEDICAL CENTER MICHAEL PHELPS 500 SOUTH MAPLE ST WACONIA MN 55387 20498188 0 X WWW.SIBLEYMEDICAL.ORG X 1948 MN TO MAKE A POSITIVE DIFFERENCE IN THE QUALITY OF LIFE AND HEALTH FOR THE PEOPLE OF OUR AREA. 9 9 102 4 0 0 2572151 65232 14820714 15148671 247571 -121358 233050 506991 17873486 15599536 8074 10654 0 0 8295571 8308119 0 0 0 6516756 6514457 14820401 14833230 3053085 766306 20429114 21953261 6592625 7603148 13836489 14350113 RIDGEVIEW SIBLEY MEDICAL CENTER EXISTS TO ENHANCE THE LIFELONG HEALTH OF PEOPLE IT SERVES WITH A CULTURE THAT NURTURES THE WHOLE PERSON: MIND, BODY, AND SPIRIT. 0 0 12509284 10654 15148671 LOCATED IN ARLINGTON, MINNESOTA, RIDGEVIEW SIBLEY MEDICAL CENTER IS A CRITICAL ACCESS HOSPITAL--PROVIDING URGENT CARE, GENERAL SURGERY, AND 24/7 HOSPITAL AND EMERGENCY SERVICES TO RESIDENTS OF SIBLEY COUNTY AND THE SURROUNDING AREA. RIDGEVIEW SIBLEY ALSO HAS CLINIC LOCATIONS IN ARLINGTON, GAYLORD, HENDERSON AND WINTHROP.RIDGEVIEW SIBLEY MEDICAL CENTER BELIEVES EVERYONE DESERVES TOP-QUALITY MEDICAL CARE AND THAT THE PEOPLE OF SIBLEY COUNTY SHOULDN'T HAVE TO TRAVEL FAR TO GET THE LATEST MEDICAL ADVANCEMENTS. IT'S THIS BELIEF THAT DRIVES US TO BRING SPECIALTY CARE TO OUR COMMUNITY. IT'S WHY WE CONSTANTLY PURSUE THE TECHNOLOGIES, RECRUIT THE EXPERTS, AND EXPAND AND IMPROVE FACILITIES THAT MAKE GREAT HEALTH CARE POSSIBLE. 12509284 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 0 0 0 0 1 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 16 0 102 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 1 1 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 0 0 0 MN X DARLA ANDERSON 9524422191 601 WEST CHANDLER STREET ARLINGTON MN 55307 KEVIN LINDSTRAND CHAIR 0.50 0.00 X X 1800 0 0 DAVID WELCH TREASURER 0.40 0.00 X X 1200 0 0 LISA PFARR SECRETARY 0.40 0.00 X X 1200 0 0 TIMOTHY DOLAN TRUSTEE 0.40 0.00 X 1200 0 0 WAYNE HUBIN TRUSTEE 0.40 2.00 X 1200 5000 0 DIANE BIAS-MOSEL TRUSTEE 0.40 0.00 X 3600 0 0 LYLE RUD TRUSTEE 0.40 0.00 X 1200 0 0 DENNIS SCHULTZ TRUSTEE 0.40 0.00 X 1200 0 0 DEE THOMAS TRUSTEE 0.40 0.00 X 1200 0 0 MICHAEL PHELPS PRESIDENT / CEO 2.00 48.00 X 0 564019 76156 GORDON GABLENZ CFO & CIO 4.00 46.00 X 0 351764 84068 BEN NIELSEN VICE PRESIDENT 1.00 49.00 X 0 265973 14108 TODD SANDBERG RSMC ADMINISTRATOR (THRU JUNE 2018) 1.00 49.00 X 0 130219 23981 13800 1316975 198313 0 0 1 0 KRAUS ANDERSON CONSTRUCTION COMPANY 501 S 8TH ST MINNEAPOLIS MN 55404 CONSTRUCTION SERVICES 2509274 EMPAC 500 S MAPLE ST WACONIA MN 55387 PHYSICIAN SERVICES 922325 ALLSCRIPTS 24630 NETWORK PLACE CHICAGO IL 60673 IT SERVICES 250510 CENTRAL MINNESOTA DIAGNOSTIC INC 525 10TH ST NE PO BOX 158 MILACA MN 56353 CT SCANS 201483 COMPHEALTH MEDICAL STAFFING PO BOX 972670 DALLAS TX 75397 PHYSICIAN SERVICES 148937 6 27449 37783 65232 NET PATIENT REVENUE 621610 15148671 15148671 15148671 102704 102704 68660 0 68660 68660 68660 4652958 4877020 -224062 -224062 -224062 11836 27449 21632 -9796 -9796 3597 0 3597 3597 MEANINGFUL USE INCOME 900099 338090 338090 JOINT VENTURE INCOME 900099 84122 84122 MISCELLANEOUS 900099 22318 22318 444530 15599536 15148671 0 385633 X 4654 4654 6000 6000 13800 13800 6758376 6430636 327740 210879 205557 5322 882043 829000 53043 443021 424001 19020 56800 56800 29496 29496 2342966 2198242 144724 13286 13152 134 73033 54194 18839 243139 243139 36442 32473 3969 34137 30131 4006 125625 125625 833620 160860 672760 37163 37163 MEDICAL SUPPLIES 1275667 1271067 4600 OTHER EXPENSES 1026231 360250 665981 BAD DEBT EXPENSE 245928 245928 MINNESOTA CARE TAX 140924 140924 14833230 12509284 2323946 0 3889852 3892972 2588308 1652217 2454605 1382500 4899 4086 297018 362957 62637 288759 14708175 2656303 8056025 12051872 2886796 2089234 188974 228664 20429114 21953261 1159050 1275884 338090 0 3906389 3657978 1189096 2669286 6592625 7603148 X 13836489 14350113 13836489 14350113 20429114 21953261 766306 -252682 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 8476 8476 0 PART II-B, LINE 1: SIBLEY MEDICAL CENTER PAYS DUES TO THE MINNESOTA HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION, A PORTION OF WHICH ARE USED FOR LOBBYING EXPENSES. 4859642 832369 4027273 166337 7933 158404 3576374 1816001 1760373 6105822 6105822 12051872 THIRD PARTY PAYOR SETTLEMENTS 965082 DUE TO RELATED ORGANIZATIONS 1704204 2669286 X 15490249 166137 166137 15324112 29496 245928 275424 15599536 14573089 15283 15283 14557806 29496 245928 275424 14833230 PART X, LINE 2: THE ORGANIZATION IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE THAT IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(C)(3) OF THE CODE. THE ORGANIZATION HAS ELECTED TO ADOPT GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE ADOPTION OF THIS STANDARD HAS NO EFFECT ON THE FINANCIAL STATEMENTS. THE ORGANIZATION'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EVENT EXPENSES 15,283. INVESTMENT INCOME 150,854. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 245,928. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EVENT EXPENSES 15,283. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 245,928. FISH HOUSE RAFFLE 20420 9002 11418 11418 506 SPRING BENEFIT 18865 18447 418 418 4472 2500 2318 39285 27449 11836 11836 4472 2500 2824 21632 -9796 1 1 X 1 X 1 X 225.000000000000 1 1 0 0 364638 364638 0.02500 2903421 2171661 731760 0.05020 3268059 2171661 1096398 0.07520 3 592 4213 4213 0.00030 2 26 6213 6213 0.00040 1 0 516 516 0.00000 6 618 10942 10942 0.00070 6 618 3279001 2171661 1107340 0.07590 9098 9098 0.00060 9098 9098 0.00060 1 245928 0 7376867 7472500 -95633 X 1 1 1 1 RIDGEVIEW SIBLEY MEDICAL CENTER 601 WEST CHANDLER STREET ARLINGTON MN 55307 WWW.SIBLEYMEDICAL.ORG HFID-00618 X X X X RIDGEVIEW SIBLEY MEDICAL CENTER 1 0 0 1 X X X X X X X X X 16 1 1 0 1 X WWW.RIDGEVIEWMEDICAL.ORG/ABOUT-US/ X 1 16 1 WWW.RIDGEVIEWMEDICAL.ORG/ABOUT-US/ 0 1 X 150.000000000000 225.000000000000 X X X 1 1 X X X X 1 X WWW.SIBLEYMEDICAL.ORG/FINANCIAL-ASSISTANCE/ X WWW.SIBLEYMEDICAL.ORG/FINANCIAL-ASSISTANCE/ X WWW.SIBLEYMEDICAL.ORG/FINANCIAL-ASSISTANCE/ X X X X X X 1 X 0 X X X X 1 X 0 0 RIDGEVIEW SIBLEY MEDICAL CENTER PART V, SECTION B, LINE 5: PRIMARY DATA WAS COLLECTED THROUGH FOCUS GROUPS, COMMUNITY PERSPECTIVE SURVEY, AND A KEY INFORMANT SURVEY.FOCUS GROUPS WERE CONDUCTED TO ALLOW PARTICIPANTS TO PROVIDE INFORMATION ABOUT THEIR EXPERIENCES IN THE COMMUNITY AND AREAS IN WHICH THEY THOUGHT THE SERVICES AND RESOURCES PROVIDED COULD BE IMPROVED. THREE FOCUS GROUPS WERE HELD AND, IN TOTAL, 21 INDIVIDUALS PARTICIPATED TO DISCUSS AND IDENTIFY COMMUNITY HEALTH NEEDS RELATED TO SPECIFIC GEOGRAPHIC REGIONS. SEE APPENDIX B IN THE 2016 CHNA REPORT, AVAILABLE ONLINE, FOR A LIST OF BUSINESSES, ORGANIZATIONS AND AGENCIES THAT PARTICIPATED IN THE FOCUS GROUPS.SIBLEY MEDICAL CENTER CONDUCTED AN ONLINE SURVEY OF COMMUNITY RESIDENTS IN JUNE 2016. THE SURVEY INSTRUMENT WAS DEVELOPED TO GATHER INFORMATION FROM RESPONDENTS ABOUT THEIR PERCEPTIONS OF HEALTH CONCERNS IN THE COMMUNITY. THE ONLINE SURVEY WAS ISSUED TO RIDGEVIEW'S EMAIL DATABASE; RESPONSES WERE RECEIVED FROM 615 PARTICIPANTS, REPRESENTATIVE OF SIBLEY MEDICAL CENTER'S SERVICE AREA. IN ADDITION TO SURVEYING THE INDIVIDUAL PERSPECTIVE OF COMMUNITY MEMBERS, SIBLEY MEDICAL CENTER SURVEYED LEADERS IN THE COMMUNITY ON THEIR PERSPECTIVE OF THE BROADER COMMUNITY HEALTH NEEDS. THE INVITED COMMUNITY LEADERS PARTICIPATED THROUGH EITHER FOCUS GROUPS OR AN ONLINE SURVEY FOR KEY INFORMANTS. RIDGEVIEW SIBLEY MEDICAL CENTER PART V, SECTION B, LINE 6A: THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED WITH RIDGEVIEW MEDICAL CENTER. RIDGEVIEW SIBLEY MEDICAL CENTER PART V, SECTION B, LINE 11: RIDGEVIEW SIBLEY MEDICAL CENTER CONTINUES TO DEVELOP BROAD COMMUNITY STRATEGIES THAT FOCUS ON FOUR HEALTH ISSUES THAT WERE IDENTIFIED AND PRIORITIZED IN THE CHNA AND IMPLEMENTATION PLAN: 1) PREVENTION, CLINICAL CARE, AND DISEASE MANAGEMENT, 2) AGING AND AGING-RELATED CONCERNS, 3) MENTAL AND BEHAVIORAL HEALTH, AND 4) ACCESS TO CARE. IN 2018, WE ENHANCED PROVIDER CARE TEAMS TO ACTIVELY FOCUS ON PATIENTS WITH DIABETES, ASTHMA AND VASCULAR DISEASE. RIDGEVIEW PROVIDED 1:1 AND GROUP DIABETIC AND OVERALL NUTRITION EDUCATION TO PATIENTS THROUGH DIABETIC EDUCATORS AND HEALTH RN NAVIGATORS. RIDGEVIEW IS ALSO A COMMITTEE MEMBER IN THE COMMUNITY ACT ON AHLZHEIMER'S TEAM. RIDGEVIEW IS ALSO PROVIDING AWARENESS ON COLORECTAL SCREENINGS BY ENHANCING PATIENT SCREENING OPTIONS AND EDUCATING COMMUNITIES THROUGH MARKETING CAMPAIGNS. 4 1 - RIDGEVIEW ARLINGTON CLINIC 601 WEST CHANDLER STREET ARLINGTON MN 55307 CLINIC 2 - RIDGEVIEW GAYLORD CLINIC 660 3RD STREET GAYLORD MN 55334 CLINIC 3 - RIDGEVIEW HENDERSON CLINIC 505 MAIN STREET HENDERSON MN 56044 CLINIC 4 - RIDGEVIEW WINTHROP CLINIC 223 NORTH CARVER STREET WINTHROP MN 55396 CLINIC PART I, LINE 3C: ELIGIBILITY FOR SIBLEY MEDICAL CENTER'S CHARITY CARE PROGRAM IS BASED ON FAMILY INCOME RELATIVE TO FEDERAL POVERTY GUIDELINES (FPG). FREE CARE IS OFFERED FOR FEDERAL ADJUSTED GROSS INCOME UP TO 150% OF FPG. 75% OF A PATIENT'S CHARGES ARE FORGIVEN FOR FEDERAL ADJUSTED GROSS INCOME UP TO 175% OF FPG. 50% OF A PATIENT'S CHARGES ARE FORGIVEN FOR FEDERAL ADJUSTED GROSS INCOME UP TO 200% OF FPG. AND 25% OF A PATIENT'S CHARGES ARE FORGIVEN FOR FEDERAL ADJUSTED GROSS INCOME UP TO 225% OF FPG.PATIENTS SEEKING ASSISTANCE MAY FIRST BE ASKED TO APPLY FOR OTHER EXTERNAL PROGRAMS (SUCH AS MEDICAID OR INSURANCE THROUGH THE PUBLIC MARKETPLACE) AS APPROPRIATE BEFORE ELIGIBILITY UNDER THIS POLICY IS DETERMINED. IF INSURANCE IS GRANTED, BUT NOT RETROACTIVELY, SIBLEY MEDICAL CENTER MAY STILL GIVE FINANCIAL ASSISTANCE TO THE INDIVIDUAL FOR PAST MEDICAL SERVICES. ADDITIONALLY, ANY UNINSURED PATIENTS WHO ARE BELIEVED TO HAVE THE FINANCIAL ABILITY TO PURCHASE HEALTH INSURANCE MAY BE ENCOURAGED TO DO SO TO HELP ENSURE HEALTHCARE ACCESSIBILITY AND OVERALL WELL-BEING. OTHER FACTORS THAT MAY QUALIFY AN ACCOUNT FOR FINANCIAL ASSISTANCE MAY INCLUDE:A. THE PATIENT HAS ENDURED A FINANCIAL HARDSHIP.B. THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE BASED ON THE INCOME/FAMILY LEVELS AS DEFINED IN THIS POLICY.C. THE FACILITY HAS RECEIVED NOTICE FOR A PERSON WHO DECLARES BANKRUPTCY.D. THE FACILITY HAS NEGOTIATED AND SETTLED FOR AN AMOUNT LESS THAN THE FULL BALANCE OF A PATIENT'S ACCOUNT. THE NEGOTIATED DISCOUNTED AMOUNT MAY QUALIFY AS FINANCIAL ASSISTANCE.E. THE PATIENT HAS EXPIRED LEAVING NO ESTATE.F. THE PATIENT HAS EXPERIENCED A CATASTROPHIC HEALTH RELATED CIRCUMSTANCE.DETERMINATIONS FOR FINANCIAL ASSISTANCE ELIGIBILITY WILL REQUIRE PATIENTS TO SUBMIT A COMPLETED FINANCIAL ASSISTANCE APPLICATION (INCLUDING ALL DOCUMENTATION REQUIRED BY THE APPLICATION) AND MAY REQUIRE APPOINTMENTS OR DISCUSSION WITH HOSPITAL FINANCIAL COUNSELORS. WHEN DETERMINING PATIENTS' ELIGIBILITY FOR FINANCIAL ASSISTANCE, RIDGEVIEW SIBLEY MEDICAL CENTER DOES NOT TAKE INTO ACCOUNT RACE, GENDER, AGE, SEXUAL ORIENTATION, RELIGIOUS AFFILIATION, OR SOCIAL OR IMMIGRANT STATUS. PART I, LINE 7: THE COSTING METHODOLOGY USED BY SIBLEY MEDICAL CENTER TO DETERMINE THE COMMUNITY BENEFIT EXPENSES INCLUDED IN PART I, LINES 7A-D WERE DERIVED BY TAKING THE RESPECTIVE AMOUNTS PER THE AUDITED FINANCIAL STATEMENTS AND APPLYING THE COST-TO-CHARGE RATIO FROM WORKSHEET 2 OF THE IRS INSTRUCTIONS. THE COMMUNITY BENEFIT EXPENSES INCLUDED IN LINES 7E-J WERE REPORTED BASED ON SMC'S ACTUAL COSTS FOR EACH CLASSIFICATION OF EXPENSES. PART I, LN 7 COL(F): BAD DEBT EXPENSES INCLUDED ON FORM 990, PART IX, LINE 24, BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $245,928 FOR THE YEAR ENDED DECEMBER 31, 2018. PART II, COMMUNITY BUILDING ACTIVITIES: IN 2018, SIBLEY MEDICAL CENTER, IN COLLABORATION WITH LOCAL SCHOOLS, LAW ENFORCEMENT, AND EMERGENCY RESPONDERS, COMPLETED A SCHOOL SHOOTER EXERCISE. THE PURPOSE OF THIS EXERCISE WAS TO DEVELOP STRATEGIES FOR PRE-PLANNING AND DAY-OF EXECUTION OF A SUCCESSFUL ACTIVE SHOOTER DRILL IN LOCAL SCHOOLS. THIS INCLUDED MULTIPLE EXERCISE PLANNING SESSIONS AND A FULL-SCALE EXERCISE. PART III, LINE 2: IN EVALUATING THE COLLECTIBILITY OF PATIENT ACCOUNTS RECEIVABLE, THE ORGANIZATION ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE ORGANIZATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE ORGANIZATION RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. PART III, LINE 3: SIBLEY MEDICAL CENTER HAS NOT IDENTIFIED A METHOD OF REASONABLY ESTIMATING THE PORTION OF ITS BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE BUT DID NOT COMPLETE AN APPLICATION. PART III, LINE 4: THE NOTE OF SIBLEY MEDICAL CENTER'S 2018 FINANCIAL STATEMENTS THAT INCLUDES THE EXPLANATION OF BAD DEBT EXPENSE IS THE "PATIENT RECEIVABLES, NET NOTE INCLUDED ON PAGE 7. PART III, LINE 8: SIBLEY MEDICAL CENTER USED THE 2018 FILED MEDICARE COST REPORT TO CALCULATE THE MEDICARE ALLOWABLE COSTS INCLUDED IN PART III, LINE 6. APPLIED AGAINST ACTUAL RECEIPTS, SIBLEY EXPERIENCED COSTS NOT COVERED BY MEDICARE IN THE AMOUNT OF $95,633 IN 2018. THIS IS A DIRECT BENEFIT TO THE MEDICARE POPULATION OF OUR COMMUNITY. PART III, LINE 9B: AT ANY POINT DURING THE BILLING AND COLLECTION PROCESS A PATIENT HAS THE ABILITY TO REQUEST AN APPLICATION FOR FINANCIAL ASSISTANCE. ONCE AN APPLICATION HAS BEEN REQUESTED, THE COLLECTION PROCESS PAUSES AND DOES NOT CONTINUE UNTIL A DETERMINATION IS MADE FOR FINANCIAL ASSISTANCE. PART VI, LINE 2: SIBLEY MEDICAL CENTER ASSESSES THE CURRENT HEALTH STATUS, HEALTH OUTCOMES, AND UNMET NEEDS IN THE COMMUNITIES IT SERVES THROUGH A FORMALIZED, RIGOROUS, AND STRUCTURED PROCESS. COMPLETION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND PUBLIC REPORTING ENSURES THAT SIBLEY MEDICAL CENTER IMPROVEMENT EFFORTS AND RESOURCES ARE ALIGNED WITH COMMUNITY HEALTH PRIORITIES.SIBLEY MEDICAL CENTER HAS AND WILL CONTINUE TO USE A CHNA AND OTHER INTERNAL AND EXTERNAL INFORMATION (INCLUDING DISCHARGE, QUALITY MEASURES, PREDICTIVE, AND POPULATION DATA) TO AID STRATEGIC PLANNING PROCESSES AND ALIGN ORGANIZATIONAL SERVICES/RESOURCES ACCORDINGLY. PART VI, LINE 4: SIBLEY COUNTY INCLUDES SEVEN CITIES. IN AGGREGATE, THE LAND SIZE IS 601 SQUARE MILES WITH A TOTAL POPULATION OF 15,028 PEOPLE. SIBLEY COUNTY IS CONSIDERED A "FRINGE" COUNTY AND IS ON THE WESTERN BOUNDARY OF THE SEVEN-COUNTY TWIN CITIES METROPOLITAN AREA. THE DISTINCT QUALITIES OF EACH COMMUNITY PROVIDE A UNIQUE BLEND OF HISTORY AND CULTURE. MANY COMMUTERS TAKE ADVANTAGE OF OUR LOWER HOUSING COSTS AND THE BENEFITS OF RURAL LIVING.AGRICULTURE IN SIBLEY COUNTY IS A MAIN SOURCE OF EMPLOYMENT AND INCOME. THERE ARE 352,000 ACRES DEDICATED TO FARMING. OF THESE FARMS, 86.55% OF THEM ARE INDIVIDUALLY/FAMILY OWNED AND OPERATED. THE AVERAGE VALUE OF THE AGRICULTURAL PRODUCTS SOLD PER FARM IS $175,079. ALONG WITH THE PRODUCTION OF CROPS, A LARGE NUMBER OF FARMS RAISE LIVESTOCK, POULTRY, AND DAIRY CATTLE.ACCORDING TO THE 2010 US CENSUS, THE MAJORITY OF THE POPULATION RESIDES IN THE CITIES OF ARLINGTON, GAYLORD, AND WINTHROP. THE POPULATION BREAKDOWN SHOWS THOSE UNDER 18 YEARS OF AGE AT 27.7%, THOSE 65 YEARS AND OVER AT 16.4%; WITH THE MEDIAN RESIDENT AGE AT 40.0 YEARS. THE POPULATION DECREASED -0.9% SINCE 2010, BUT OVERALL THE POPULATION HAS STAYED CONSISTENT OVER THE LAST DECADE. PART VI, LINE 5: SIBLEY MEDICAL CENTER PROVIDES COMMUNITY EDUCATION AND WORKS WITH HEALTH CARE PROVIDERS IN MEEKER, MCLEOD AND SIBLEY COUNTIES TO IMPROVE THE HEALTH OF OUR COMMUNITY. PART VI, LINE 6: SIBLEY MEDICAL CENTER IS A 109-BED ACUTE CARE HOSPITAL IN WACONIA, MINNESOTA THAT PROVIDES HEALTHCARE SERVICES TO THE RESIDENTS OF THE WEST SUBURBAN METROPOLITAN AREA OF MINNEAPOLIS AND ST. PAUL AND ADJACENT RURAL AREAS OF MN. RIDGEVIEW MEDICAL CENTER'S SUBSIDIARIES INCLUDE: RIDGEVIEW CLINICS PROVIDES OUTPATIENT HEALTHCARE SERVICES FROM VARIOUS CLINIC LOCATIONS THROUGHOUT THE WEST SUBURBAN METROPOLITAN AREA OF MINNEAPOLIS AND ST. PAUL AND ADJACENT RURAL AREAS OF MINNESOTA. SIBLEY MEDICAL CENTER (DBA: RIDGEVIEW SIBLEY MEDICAL CENTER) IS A CRITICAL ACCESS HOSPITAL PROVIDING URGENT CARE, GENERAL SURGERY, AND 24/7 HOSPITAL AND EMERGENCY SERVICES TO RESIDENTS OF SIBLEY COUNTY AND THE SURROUNDING AREA. RIDGEVIEW SIBLEY MEDICAL CENTER ALSO HAS CLINICAL LOCATIONS IN ARLINGTON, GAYLORD, HENDERSON AND WINTHROP.MINNESOTA VALLEY HEALTH CENTER (DBA: RIDGEVIEW LE SUEUR MEDICAL CENTER) OPERATES A 15-BED ACCUTE CARE HOSPITAL, A 55-BED NURSING HOME, AND A 37-UNIT HUD APARTMENT BUILDING FOR THE ELDERLY.CHASKA PLAZA SURGERY CENTER IS A PARTNERSHIP IN WHICH RIDGEVIEW MEDICAL CENTER OWNS A 51% INTEREST.MINNEAPOLIS HEART INSTITUTE AT RIDGEVIEW HEART CENTER PROVIDES CARDIOLOGY SERVICES. THE HEART INSTITUTE IS A PARTNERSHIP IN WHICH RIDGEVIEW MEDICAL CENTER HOLDS A 50% INTEREST. WACONIA BUILDING INVESTMENTS OWNS A MEDICAL OFFICE BUILDING ON RIDGEVIEW MEDICAL CENTER'S CAMPUS. RIDGEVIEW REAL ESTATE LLC HOLDS THE LAND LEASE FOR WACONIA BUILDING INVESTMENTS. RIDGEVIEW COMMUNITY NETWORK OPERATES AN ACCOUNTABLE CARE ORGANIZATION. RIDGEVIEW INSURANCE COMPANY OPERATES A CAPTIVE INSURANCE COMPANY FOR THE BENEFIT OF RIDGEVIEW MEDICAL CENTER. RIDGEVIEW FOUNDATION OPERATES FOR THE EXCLUSIVE BENEFIT OF RIDGEVIEW MEDICAL CENTER. 1 SCHOLARSHIPS 3 6000 0 1 0 0 0 1 1 0 0 MICHAEL PHELPS PRESIDENT / CEO 0 488825 0 75194 0 0 0 11000 0 65156 0 640175 0 0 GORDON GABLENZ CFO & CIO 0 305950 0 45814 0 0 0 24113 0 59955 0 435832 0 0 BEN NIELSEN VICE PRESIDENT 0 237709 0 28264 0 0 0 9820 0 4288 0 280081 0 0 TODD SANDBERG RSMC ADMINISTRATOR (THRU JUNE 2018) 0 101440 0 28779 0 0 0 0 0 23981 0 154200 0 0 PART I, LINE 3 THE ADMINISTRATOR'S COMPENSATION IS DETERMINED BY RIDGEVIEW MEDICAL CENTER, THE SOLE MEMBER. THE FOLLOWING WERE USED BY RIDGEVIEW MEDICAL CENTER TO DETERMINE THE ADMINISTRATOR'S COMPENSATION: 1. COMPENSATION COMMITTEE (EXECUTIVE COMMITTEE) 2. INDEPENDENT COMPENSATION CONSULTANT 3. FORM 990 OF OTHER ORGANIZATIONS 4. WRITTEN EMPLOYMENT CONTRACT 5. COMPENSATION SURVEY OR STUDY 6. APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE (EXECUTIVE COMMITTEE) PART I, LINE 4B MICHEL PHELPS PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT SPLIT-DOLLAR WHOLE LIFE PLAN AT RIDGEVIEW MEDICAL CENTER. DURING 2018, $0 WAS CONTRIBUTED TO THE PLAN, $26,930 WAS ACCRUED WITHIN THE PLAN, AND $0 WAS PAID OUT OF THE PLAN. GORDON GABLENZ PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT SPLIT-DOLLAR WHOLE LIFE PLAN AT RIDGEVIEW MEDICAL CENTER. DURING 2018, $0 WAS CONTRIBUTED TO THE PLAN, $16,003 ACCRUED WITHIN THE PLAN, AND $0 WAS PAID OUT OF THE PLAN. THESE DEFERRED COMPENSATION AMOUNTS ARE REPORTED ON A PRO-RATA BASIS WITHOUT REGARD TO THE INDIVIDUAL'S VESTING SCHEDULE. CURRENTLY, THE MAJORITY OF DEFERRED COMPENSATION IS NOT VESTED. PART I, LINE 6 THE OFFICERS OF RIDGEVIEW MEDICAL CENTER AND AFFILIATES RECEIVE BONUSES CONTINGENT ON THE NET EARNINGS OF THE CONSOLIDATED ENTITY AND GOALS ACHIEVED. FORM 990, PART VI, SECTION A, LINE 3 ALL MANAGEMENT SERVICES ARE PROVIDED BY RIDGEVIEW MEDICAL CENTER FORM 990, PART VI, SECTION A, LINE 4 THE BYLAWS WERE AMENDED IN FEBRUARY 2018 (A) TO CHANGE THE MINIMUM FREQUENCY OF BOARD MEETINGS FROM MONTHLY TO QUARTERLY, AND (B) TO MODIFY THE COMPOSITION OF THE BOARD'S NOMINATING COMMITTEE. FORM 990, PART VI, SECTION A, LINE 6 RIDGEVIEW MEDICAL CENTER IS THE SOLE MEMBER OF RIDGEVIEW SIBLEY MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 7A DIRECTORS ARE ELECTED BY THE RIDGEVIEW MEDICAL CENTER BOARD. ANY DIRECTOR MAY ALSO BE REMOVED BY THE RIDGEVIEW MEDICAL CENTER BOARD. FORM 990, PART VI, SECTION A, LINE 7B THE BOARD OF DIRECTORS WILL CARRY OUT THE DUTIES NORMALLY ASSOCIATED WITH A NONPROFIT HOSPITAL BOARD OF DIRECTORS, SUBJECT TO THE RESERVED POWERS OF THE MEMBER AND THE CITY BELOW. THE MEMBER RESERVES AUTHORITY WITH REGARD TO THE MATTERS LISTED BELOW, SUBJECT TO THE RESERVED POWERS OF THE CITY INCLUDED THEREAFTER. THE MEMBER WILL LOOK TO THE BOARD TO MAKE RECOMMENDATIONS ON DECISIONS ON MATTERS LISTED BELOW, BUT THE MEMBER IS NOT REQUIRED TO ACCEPT SUCH RECOMMENDATIONS, AND THE MEMBER MAY TAKE ACTION ON ITS OWN IN SUCH AREAS, SUBJECT TO THE CITY'S RESERVED POWERS. THE MEMBER'S APPROVAL WILL BE REQUIRED FOR ANY ACTION PROPOSED BY THE BOARD IN THESE AREAS: (A) FINAL APPOINTMENT OF BOARD MEMBERS; (B) ISSUANCE OF DEBT BY THE CORPORATION; (C) SALE OF SUBSTANTIAL ASSETS OF THE CORPORATION; (D) CHANGES IN THE CORPORATION'S ARTICLES OF INCORPORATION AND BYLAWS; (E) ESTABLISHMENT OF ANOTHER MEMBER RELATIONSHIP BY THE CORPORATION OR ANOTHER FORM OF AFFILIATION; (F) STRATEGIC PLAN FOR THE CORPORATION; (G) OPERATING AND CAPITAL BUDGETS OF THE CORPORATION; (H) UNBUDGETED TOTAL ANNUAL CAPITAL EXPENDITURES; (I) AUDIT AND COMPLIANCE PROGRAMS; (J) ACCREDITATION PROGRAMS; (K) GROUP EMPLOYEE BENEFITS; (L) MANAGING THE CORPORATION'S CASH AND INVESTMENTS (THE MEMBER MAY MOVE FUNDS BETWEEN THE ORGANIZATIONS FREELY, SUBJECT TO BOND COVENANT OR TRUSTEE REQUIREMENTS); (M) THIRD PARTY PAYER CONTRACTING; (N) INSURANCE; (O) INFORMATION SYSTEM DESIGN AND IMPLEMENTATION; AND (P) GROUP PURCHASING. THE CITY'S APPROVAL WILL BE REQUIRED FOR THE DECISIONS OF THE BOARD IN THE FOLLOWING AREAS: (A) SALE OF ALL OR SUBSTANTIALLY ALL OF THE CORPORATION'S ASSETS; (B) SALE OF ASSETS ABOVE THRESHOLDS ALLOWED BY BOND COVENANTS; (C) ISSUANCE OF DEBT WHICH WOULD OBLIGATE THE CORPORATION IN EXCESS OF LEVELS ALLOWED BY BOND COVENANTS; AND (D) CHANGES TO THE CORPORATION'S ARTICLES OF INCORPORATION OR BYLAWS. FORM 990, PART VI, SECTION B, LINE 11B THE CFO REVIEWED THE FORM 990 AND PROVIDED COPIES TO THE BOARD OF DIRECTORS FOR REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD MEMBERS ANNUALLY REVIEW AND SIGN THE STATEMENTS FOR POTENTIAL CONFLICTS OF INTEREST. EACH MEMBER IS EXPECTED TO DISCLOSE ANY CONFLICT OF INTEREST THAT MAY ARISE DURING THE YEAR. IF IT IS DETERMINED THAT A CONFLICT OF INTEREST EXISTS, THE SITUATION WILL BE EXAMINED AND HANDLED APPROPRIATELY BY THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 ANY COMPENSATION RECEIVED BY OFFICERS OR BOARD MEMBERS IS DETERMINED BY RIDGEVIEW MEDICAL CENTER, THE SOLE MEMBER. FORM 990, PART VI, SECTION C, LINE 19 THE FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G MEDICAL SERVICES AND OTHER MISCELLANEOUS SERVICES: PROGRAM SERVICE EXPENSES 2,198,242. MANAGEMENT AND GENERAL EXPENSES 144,724. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,342,966. RIDGEVIEW MEDICAL CENTER 500 SOUTH MAPLE STREET WACONIA MN 55387 311667875 HEALTH CARE SERVICES MN 501(C)(3) LINE 3 N/A 0 RIDGEVIEW FOUNDATION 500 SOUTH MAPLE STREET WACONIA MN 55387 411328097 RAISING FUNDS FOR RIDGEVIEW MEDICAL CENTER MN 501(C)(3) LINE 7 RIDGEVIEW MEDICAL CENTER 0 RIDGEVIEW INSURANCE COMPANY 60 E SOUTH TEMPLE STE 1800 SALT LAKE CITY UT 84111 454109041 CAPTIVE INSURANCE COMPANY UT 501(C)(3) LINE 12A, I RIDGEVIEW MEDICAL CENTER 0 RIDGEVIEW CLINICS 500 SOUTH MAPLE STREET WACONIA MN 55387 411651783 HEALTH CARE SERVICES MN 501(C)(3) LINE 3 RIDGEVIEW MEDICAL CENTER 0 MINNESOTA VALLEY HEALTH CENTER 621 SOUTH 4TH STREET LE SUEUR MN 56058 410837659 HEALTH CARE SERVICES MN 501(C)(3) LINE 3 RIDGEVIEW MEDICAL CENTER 0 MINNEAPOLIS HEART INSTITUTE AT RIDGEVIEW HEART CENTER LLC 500 S MAPLE ST WACONIA MN 55387 205785920 CARDIOLOGY SERVICES MN N/A CHASKA PLAZA SURGERY CENTER 3000 HUNDERTMARK RD CHASKA MN 55318 450975783 SURGERY SERVICES MN N/A EXECUTIVE HEALTH MANAGEMENT SERVICES 500 SOUTH MAPLE STREET WACONIA MN 55387 411760239 MANAGEMENT SERVICES MN N/A C 0 CHARITABLE REMAINDER UNITRUST (1) CHARITABLE TRUST MN N/A 0 0 0 1 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0